Friday, August 29, 2014

THE TREATMENT OF CANCER WITH CHINESE MEDICINE

I am presenting here the Chinese medicine view of cancer with patterns, treatment  principle, herbs and herbal formulae. Very many of our patient have or have had cancer (or will have cancer) and, for this reason, I think it is extremely important to understand cancer from the point of view of Chinese medicine, even if we do not actually treat it.  Moreover, even if we do not treat cancer itself, we can do our patients who have survived cancer a great service if we can develop treatment strategies to prevent recurrence. 

All Chinese books try to “prove” that the concept of cancer was already in the Nei Jing and other later books.  The truth is that, while the ancient books have a fairly comprehensive theory of tumours, there was no concept of malignancy or of differentiation between benign and malignant tumours.  

There are, however, some passages that clearly indicate that, when treating tumours, the ancient doctors were well aware when a condition indicated a poor prognosis.  

For example, a text of the Song dynasty says when describing ru yan, i.e. a hard breast lump: “If it has not broken, the patient can be saved.  If it has broken, treatment is difficult. On palpation, it is as hard as a rock, hence the name [ru yan, breast rock].  If treated too late, it will ulcerate and spread to the Zang organs and is fatal.”

Please note that some of the descriptions of tumours in the ancient books (as the one above) actually describe secondary infections from cancer rather than the cancer pathology itself. The tongue below shows one such case.  We will very seldom see such infections because women will seek Western treatment much earlier than ancient Chinese women would have done.  




Moreover, the Chinese medicine theory of cancer refers only to masses and therefore 
does not envisage cancer without masses such as blood tumours (leukemia, myeloma).  

In spite of the fact that Chinese medicine had no concept of malignancy, I believe it has a lot to offer in four areas:

1) Treat the cancer itself without Western treatment
2) Treat the cancer in integration with Western treatment
3) Treat the side-effects of chemotherapy and radiotherapy
4) Prevent recurrence after Western treatment.

Chapter 55 of the Nan Jing introduces the term Ji Ju indicating "masses".

How to distinguish between Ji [积] and Ju [聚]?  Ji [masses] are Yin and Ju [masses] are Yang. Yin is deep and hidden; Yang is superficial and moves. When Qi accumulates it gives rise to Ji [masses]; when Qi gathers it gives rise to Ju [masses].  Ji [masses] originate from the 5 Zang; Ju [masses] originate from the 6 Fu.  Ji [masses] are made of Yin Qi and have a fixed location and pain, and have boundaries above and below, and edges to the right and left [i.e. they have clearly defined borders].  Ju [masses] are made of Yang Qi and seem to start from nowhere, without a boundary above and below and with a moving pain."

Abdominal masses are called Ji Ju [积 聚].  Ji indicates actual abdominal masses which are immovable; if there is an associated pain, its location is fixed.  These masses are due to stasis of Blood.  I call them "Blood masses".  

Ju indicates abdominal masses which come and go, do not have a fixed location and are movable; if there is an associated pain, it too comes and goes and changes location.  Such masses are due to stagnation of Qi.  I call them "Qi masses". 

Actual abdominal lumps therefore pertain to the category of abdominal masses and specifically Ji masses, and are due to Blood stasis.  I call them “Blood masses”.    

Another name for abdominal masses was Zheng Jia [癥瘕],  Zheng being equivalent to Ji, i.e. actual, fixed masses and Jia to Ju, i.e. non-substantial masses from stagnation of Qi.  

Zheng Jia is normally used in referring to abdominal masses that generally occur only in women; but they do occur in men as well, though rarely.  

The “Su Wen” in chapter 60 says: “Diseases of the Ren Mai...in women are masses below the waist."   

In this context, the “Su Wen” uses the term Jia-Ju, i.e. non-substantial masses from Qi stagnation.

The "Prescriptions of the Golden Cabinet“ [Jin Gui Yao Lue] by Zhang Zhong Jing 
says: "Ji masses arise from the Yin organs and they cannot be moved;  Ju masses arise from the Yang organs, they come and go, the pain has no fixed location, and they are easier to treat."

The "General Treatise on the Aetiology and Symptoms of Diseases" (AD 610) says: "Abdominal masses are due to cold and heat not being regulated [i.e. exposure to extremes of  weather], irregular diet and stagnation of the Qi of the Yin organs.  If they do not move they are called Zheng; if they are movable they are called Jia.  "Jia" implies the meaning of "false": this is because these masses can come and go and are not actual masses."


Terminology

Liu 瘤 tumour

Zhong Liu 肿 瘤 tumour, cancer

Shi Yong 石 痈 Stone Carbuncle, a condition described in the old books that could correspond to some cancers

Ai 癌 modern word for cancer

Yan 岩 “rock”, a description of some tumours that are hard and that could correspond to cancer

Ji Ju (Nan Jing, 55) 积 聚 masses, described in chapter 55 of the Nan Jing

Zheng Jia 癥 瘕 gynaecological abdominal masses 


Aetiology and pathology of cancer




Patterns

The main patterns appearing in cancer are Blood stasis, Phlegm and Toxic Heat.

Blood stasis: abdominal masses, cancer of colon, carcinoma of breast, ovarian cancer.

Phlegm: brain tumour, breast carcinoma, lymphoma.

Toxic Heat: cancers that spread rapidly.

Dampness: skin cancer (only cancer characterized by Dampness).

NOTE: many types of cancer have both Blood stasis and Phlegm.  Example: breast, colon, lung, prostate.

That is why the combination of Blood stasis and Phlegm is particularly serious and, in a patient without cancer, it should be actively treated.  

The tongue is an important factor to diagnose the combination of Blood stasis and Phlegm.

Blood stasis: purple, stiff.
Phlegm: swollen, sticky coating.


Purple, swollen


Purple, swollen, sticky coating


Purple, swollen


Purple, swollen

TREATMENT STRATEGIES

a) DIFFERENCE BETWEEN CANCER AND OTHER DISEASES: UNDERLYING QI XU

b) IDENTIFICATION OF PATTERNS IS BASIS OF TREATMENT BUT NOT ENOUGH

c) DIFFERENT APPROACH TO TREATMENT

d) INTEGRATE CHINESE DIAGNOSIS WITH WESTERN DIAGNOSIS

e) INTEGRATE CHINESE WITH WESTERN TREATMENT

f) NOT ALL CANCERS ARE THE SAME CHINESE DISEASE

a) UNDERLYING QI XU

Cancer is seen differently than any other disease as we can always assume there is an underlying Qi Xu.  I mean “Qi” in a general sense of Zheng Qi, therefore including Qi, Yang, Blood or Yin Xu. 

In other diseases, we never assume that there is a Qi Xu.  We can assume there is a situation of Qi Xu in cancer as this develops over a long period of time from accumulation of Qi, Blood, Phlegm which cannot occur without an underlying Qi Xu. 

Another important difference is that in cancer, the disease itself consumes Qi.

Please note that, just because there is Qi Xu, it does not mean that we tonify Zheng Qi in all cases of cancer. 

b) IDENTIFICATION OF PATTERNS IS BASIS OF TREATMENT BUT NOT ENOUGH

We cannot treat cancer without a pattern differentiation as we do in any other disease.  However, pattern identification alone is not enough in cancer.

One reason is that we can assume there is always Zheng Qi Xu while we should never make such assumptions in other diseases.

Another difference is that the choice of herbs is guided not only by pattern differentiation but also by modern research on anti-cancer effect.

Another factor is surgery for cancer.  After surgery for cancer, we cannot entirely diagnose from a Chinese perspective.  For example, in breast lumps (benign or malignant) we diagnose from palpation (Phlegm or Blood stasis): this is obviously no longer possible after surgery.

c) DIFFERENT APPROACH TO TREATMENT

The first difference is that in cancer we can assume that there is a deficiency of Zheng Qi and therefore we must use some tonics in every case. 

The second important difference is that the choice of herbs is guided also by modern research.  

The third important difference is in the treatment principle according to stage of disease.  In other diseases, generally in the beginning stage one expels pathogenic factors and in the late stage one tonifies.  

It is the opposite in cancer, i.e. in the beginning stage one primarily tonifies and in the late stage one primarily expels pathogenic factors.

The emphasis is in the word “primarily” as one always adopts both approaches in each stage. 

An example of another disease might be MS.  In the beginning stages, there is invasion of Dampness and the treatment principle is therefore to eliminate Dampness.  If the disease progresses, there will be deficiency of Stomach and Spleen and, later, deficiency of Yin of Liver and Kidneys.  In late stages therefore one must tonify Zheng Qi.

In cancer, the beginning stage is characterized by deficiency of Zheng Qi (without which there would not be cancer) and one should therefore primarily tonify to prevent the cancer from growing and spreading.  In late stages, the pathology of cancer is characterized by strong pathogenic factors, i.e. Blood stasis, Phlegm and Toxic Heat. 

I repeat, the stress is on the word “primarily” as we always adopt both treatments, i.e. tonify Zheng Qi and expel pathogenic factors but in different proportions according to stage. 

                                     BEGINNING STAGE        LATE STAGE
OTHER DISEASES Expel pathogenic factor     Tonify Zheng Qi

CANCER                      Tonify Zheng Qi                  Expel pathogenic factors

d) INTEGRATE CHINESE DIAGNOSIS WITH WESTERN DIAGNOSIS

This is of course very obvious.  We should never rely on palpation and a Chinese diagnosis in breast lumps, for example.  The same applies to any other cancer.  

Another example would be that of prostate cancer.  If a man has urinary retention, we should never treat that without a prostate biopsy to ascertain whether there is carcinoma.  

Western diagnosis also presents us with new opportunities that ancient Chinese doctors would not have had.  For example, when cervical dysplasia is diagnosed with a Pap smear test, we can treat that (usually very successfully) before it may turn into cervical cancer. 

e) INTEGRATE CHINESE WITH WESTERN TREATMENT


In most cases, we need to integrate our treatment with Western treatment, i.e. chemotherapy, radiotherapy and surgery.

The only times I used only Chinese treatment was when the patient themselves were strongly against Western treatment. 

During chemotherapy and radiotherapy, our attention is not directed at treating the cancer but only at supporting Zheng Qi during such treatments.

After chemotherapy and radiotherapy, we should make a clear diagnosis as to whether there are still strong pathogenic factors or not in order to decide whether we should primarily tonify or primarily expel pathogenic factors.  

f) NOT ALL CANCERS ARE THE SAME CHINESE DISEASE

Besides doing a pattern identification [Bian Zheng] we must also identify the disease [Bian Bing] as cancer manifests with a wide variety of Chinese “diseases”.  Thus we must be familiar with the aetiology and pathology of the Chinese disease with which cancer manifests. 

Thus, although we must treat cancer differently than other diseases, we must also master the aetiology and pathology of the Chinese disease corresponding to the particular type of cancer we are treating.  That will give us many indications as to treatment, choice of prescriptions and useful herbs. 

The following Tables illustrate the correspondence between Chinese diseases and types of cancer. 

ZANG TUMOURS

LOCATION CHINESE PINYIN     MEANING                       POSSIBLE CANCER
Liver              干 积            Gan Ji         Liver accumulation         Liver carcinoma
Spleen            脾 积            Pi Ji            Spleen accumulation       Carcinoma of pancreas
Lung              肺 积             Fei Ji          Lung accumulation          Lung cancer
Kidney           肾岩             Shen Yan   Kidney cancer (“rock”)   Kidney cancer


FU TUMOURS

CHINESE PINYIN            MEANING                     POSSIBLE CANCER
胃 反         Wei Fan             Stomach rebellious     Liver carcinoma
噎 膈         Ye Ge                 Dysphagia                     Carcinoma of pancreas
脑 沙         Nao Sha             Brain “Sand”                 Lung cancer
鎖 肛 痔    Suo Gang Zhi    Haemorrhoids               Kidney cancer
积聚          Ji Ju Masses      Abdominal masses       Gynaecological masses
腸 痰         Chang Tan         Intestines Phlegm        Colon cancer (ovarian cancer)


CHANNEL TUMOURS

CHINESE PINYIN       MEANING                         POSSIBLE CANCER
瘰 疬         Luo Li          Scrofula                                 Lymphoma
痰 結         Tan Jie         Phlegm accumulation          Lymphoma (lipoma)
石 疔         Shi Ding        Stone Boil                             Skin cancer
肉 痳         Rou Lin        Lumps under skin                Lymphoma (lipoma)
石 廮         Shi Ying        Stone Goitre                         Carcinoma of thyroid
妒 乳        Du Ru           “Jealous Breast”                    Breast carcinoma
失 榮        Shi Rong        Loss of Lustre (neck lump) Lymphoma, sarcoma
石 阻        Shi Zu            Stone Obstruction                 Skin cancer
恶 核        E He               Obstinate Nodule                 Lymphoma



OTHER TUMOURS

CHINESE PINYIN     MEANING                  POSSIBLE CANCER
勞 瘵         Lao Zhai     Consumption Disease   Late stage of any cancer
虛 勞         Xu Lao       Exhaustion                    Late stage of any cancer
熱 癆         Re Lao       Heat Exhaustion            Leukemia
骨 癆         Gu Lao       Bone Consumption       Bone cancer
喉 痹         Hou Bi        Throat Bi                      Throat cancer
膈 肿         Ge Zhong    Diaphragm swelling Carcinoma oesophagus
石 瘕         Shi Jia         Stone Masses               Carcinoma uterus


APPROACH TO TREATMENT AFTER WESTERN TREATMENT 

It is important to have a clear idea how to approach the treatment of a patient after he or she has had Western treatment (chemotherapy, radiotherapy or surgery) as we will see very many patients after such treatment.  

The approach depends on the type of treatment they had.  Basically, one must decide whether we should primarily tonify the Zheng Qi with the aim of preventing recurrence of the cancer or whether we should still primarily expel pathogenic factors in spite of the Western treatment received.  

For example, if a woman had breast cancer from Phlegm and she had a mastectomy, does it make sense to still resolve Phlegm?  In some cases, yes.  I choose the treatment principle a lot according to tongue and pulse.  If the tongue and pulse show a Full condition, then I primarily expel pathogenic factors, but always with the addition of herbs to tonify Zheng Qi and support the immune system.

Tongues indicating a primarily Full conditions: swollen, thick coating, purple, stiff.

Tongues indicating a primarily Empty condition: not so purple, not swollen, thin coating or no coating.  


Purple, thick coating

Purple, swollen

Red, thick-dry coating

A pulse indicating a Full condition is Full, Slippery or Wiry and possibly Rapid.

A pulse indicating an Empty condition is Weak, Fine or Choppy. 

Thus, if the tongue and pulse indicate a primarily Full condition, I treat the patient as if they still had the cancer.

How to choose the herbal formula?  First of all, I refer to the Chinese disease corresponding to that type of cancer in order to see if there is a Chinese formula that can be adapted to the patient.  

Apart from the Chinese disease, the formula must also be based on the pattern: therefore a good pattern identification is essential.

I then modify the formula is three ways:

1) Make additions or subtractions according to the patient’s condition in the same way as I would for any disease. 

2) Add 2-3 herbs that have a proven anti-cancer effect according to modern research.  Is there herbs also treat the presenting pattern, even better.  For example, Huang Yao Zi has an anti-cancer effect and resolves Phlegm: we would therefore choose that herb if there is Phlegm.

3) Add 2-3 herbs that tonify Zheng Qi and stimulate the immune system.  If they also have an anti-cancer effect, all the better.  


APPROACH TO TREATMENT DURING CHEMOTHERAPY AND RADIOTHERAPY TREATMENT

During treatment with chemotherapy and radiotherapy, I do not treat the patterns, but only tonify Zheng Qi in order to support the organism during this treatment.

For chemotherapy, I use the Three Treasures remedy Chemo-Support and for radiotherapy Radio-Support.  The treatment principle of Chemo-Support is to tonify Zheng Qi, resolve Dampness and clear Heat. 

For radiotherapy, I use the Three Treasures remedy Radio-Support.  The treatment principle of Radio-Support is to nourish, cool and invigorate Blood. 

More information on Chemo-Support can be found on: 
http://www.three-treasures.com/newsletters/summer05.html

More information on Radio-Support can be found on: 
http://www.three-treasures.com/newsletters/winter00.html

More information on chemotherapy and antioxidants can be found on:
http://www.three-treasures.com/newsletters/spring10.html


Please note that the effects of radiotherapy can be long-lasting and I therefore advocate using Radio-Support for at least 9 months after the end of the treatment. 

Saturday, July 12, 2014

THE SIDES OF THE TONGUE


As the previous blog on the chest/breast area of the tongue has aroused some questions about the sides of the tongue, I would like to clarify some diagnostic aspects of the sides of the tongue.

Of course the sides of the tongue reflect the state of the Liver but there are circumstances when they reflect the state of the Spleen.

The area on the sides reflecting the Liver is long and rather narrow.  By “long” I mean that it extends almost from the root to near the tip.  A redness of this area is very common and it indicates Liver-Heat.

Liver areas













Red sides, Liver area












Swollen sides, Liver area














The area on the sides reflecting the Spleen differs from that reflecting the Liver in two ways:
1) it is less long, being concentrated in the middle section of the tongue (Middle Burner);
2) it is wider.

A common change in this area is a swelling which indicates Dampness in the Spleen.  It also is often pale, indicating Spleen deficiency.  If it is pale and swollen it indicates Spleen-Qi deficiency leading to Dampness.  The Spleen area may also be red indicating Spleen-Heat.

Spleen areas



















Spleen areas














Swelling Spleen areas













Redness Spleen areas

Compare this redness on the sides with the redness in the Liver areas above (first picture)










The chest/breast/ area is completely different being confined to a relatively small area between the middle section of the tongue and the tip.

Chest/breast areas


Wednesday, July 9, 2014

CHEST/BREAST AREA OF THE TONGUE

The “chest/breast” area is on the sides of the tongue, between the centre part and the tip.




The chest area reflects a pathology of three organs: heart or lungs in men and women or breast in women.

The chest area reflects pathologies of the lungs, heart or breast but in a Western medical sense.  A change in the chest area may involve a change in colour or body shape.  In women, how to differentiate when a change in the chest area indicates a problem of the lungs or heart or of the breasts?  In women, a change in the chest area indicates a pathology of the breast rather that of lungs/heart when two conditions are fulfilled:

1) In the absence of an obvious lungs/heart pathology
2) Especially when it is unilateral

Thus:
Men: lung, heart
Women: lung, heart, breast

Examples of lung pathology manifesting in the chest area are chronic asthma or chronic emphysema (in which case the chest area would be swollen and possibly purple). An example of heart pathology is chronic coronary heart disease (in which case the chest area would be purple).

As the area on the sides between the centre and the tip reflects the condition of heart/ lungs/ breast, I call this the “chest area”.

Changes in this area to look for are:
1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
3) Red points
4) Lack of coating

In women, a purple colour in the breast area indicates Blood stasis in the breast.  Blood stasis in the breast may cause masses such as fibroadenoma or carcinoma.




Purple breast area left side










Purple breast area both sides









Purple breast area left side (also without coating)







Although we should never assume that a purple colour in the breast area indicates carcinoma of the breast, we should always take it seriously and treat it by invigorating Blood in the breast.

In case of carcinoma of the breast, there is a correlation between the purple colour of the breast area and the prognosis: the darker this area, the worse the prognosis.

If the breast area on the tongue is purple in women who have not been diagnosed with breast cancer, this sign may indicate a tendency towards the disease before any symptoms manifest; for this reason, observation of the chest/breast area in women is particularly relevant. When I do tongue diagnosis in a woman, I always check the chest/breast area carefully.

Apart from a purple colour, other possible changes in the chest area are teeth marks that are confined only to the chest area, red points, the absence of coating in the chest area and a swelling.

In women, teeth marks only in the chest area indicate usually a problem in the breast (possible carcinoma) occurring against a background of severe Qi deficiency.





Teethmarks breast area right side








Red points in the chest area indicate Toxic Heat in the lungs or breast.





Red points chest/breast area right side







In women, an absence of coating in the chest/breast area indicates a possible problem in the breast occurring against a background of Yin deficiency.





No coating breast area left side










No coating breast area left side










No coating breast area left side






In women, a swelling in the breast area indicates Phlegm in the breast (which may cause fibrocystic disease or also contribute to the development of carcinoma of the breast).




Swelling breast area both sides






The Women's Treasure remedy Clear the Moon resolves Phlegm and invigorates Blood in the breast.

Clear the Moon

Sunday, June 8, 2014

SPLEEN-YIN DEFICIENCY

When we study the pathology of the Internal Organs, for the Spleen, we generally emphasize Spleen-Qi and Spleen-Yang deficiency. This is understandable as these two patterns are indeed extremely common. By contrast, when it comes to the Stomach, we do mention Stomach-Yin deficiency. In fact, some people say that this is a well-known contradiction: the Stomach is a Yang organ but it suffers from Yin deficiency while the Spleen is a Yin organ but it suffers from Yang deficiency.

All this is true, but in this article, I want to discuss the aetiology, pathology, diagnosis and treatment of Spleen-Yin deficiency. 

Historical development
Although we nowadays emphasize Spleen-Yang deficiency, some of the old classics did often mention Spleen-Yin deficiency. For example, the Su Wen in chapter 3 says that the excessive use of bitter foods or herbs causes Spleen-Qi not to be “immersed”. Modern doctors interpret “Spleen-Qi not immersed” as Spleen-Yin deficiency. 

Doctor Wang Lun Ti (Ming dynasty) said that Stomach-Fire may injure Spleen-Yin.  Qin Huang Shi (1706) says in Zheng Yin Mai Zhi: “The Spleen may be deficient in Yang or Yin: in Spleen-Yin deficiency, there is deficiency of Spleen-Blood and Empty Heat arises.” 

Tang Zong Hai, author of “Xue Zheng Lun” bemoaned the fact that, since Li Dong Yuan (author of “Pi Wei Lun”), doctors paid attention to Spleen-Yang but not Spleen-Yin. 

Aetiology
The aetiology of Spleen-Yin deficiency is clearly dietary.  It is caused by irregular eating, i.e. eating in a hurry, eating standing up, eating while working at one’s computer, eating late at night, eating while discussing business, eating while in a state of worry, etc. 

However, besides the dietary causes, Spleen-Yin deficiency may also be caused by emotional stress related to worry and pensiveness and by excessive physical work that depletes the Spleen.

Clinical manifestations
The main clinical manifestations of Spleen deficiency are:

Poor appetite, distension after eating, dry stools, dry mouth and throat, dry lips, thin body, dull complexion without lustre, night-sweating, 5-palm heat (only if there is Empty Heat), bleeding (in small quantity), tongue without coating (red if there is Empty Heat), Fine pulse.1 

Please note that Empty Heat does derive from Yin deficiency but someone may have Yin deficiency for years before Empty Heat develops.  The tongue is in fact the best clinical sign to distinguish when Yin deficiency has given rise to Empty Heat: if the tongue lacks a coating but it is not red, there is Yin deficiency without Empty Heat.  If the tongue lacks a coating and it is red, then there is Yin deficiency and Empty Heat (Plates 1 and 2 and Fig. 1).

Plate 1 (no coating, normal colour)

Plate 2 (no coating, red colour)

Fig. 1. Progression of Yin deficiency and development of Empty Heat 


The Spleen controls yun hua, i.e. transportation and transformation of food essences.  Yun Hua is impaired not only when Spleen-Yang si deficient but also when Spleen-Yin is deficient, hence the lack of appetite. The Yin deficiency causes the loss of weight and therefore thin body. 

Spleen-Yin includes Blood and Ying and for this reason Spleen-Yin deficiency may cause bleeding such as in the stools, vomit or under the skin. 

Please note the sign of dry lips as this is quite a key sign of Spleen-Yin deficiency.

Chinese journals often include symptoms and signs of Empty Heat with Spleen-Yin deficiency and they say that this pattern cause the flaring up of the pathological Minister Fire. I tend to disagree with this view.  In chronic, long-standing cases, Spleen-Yin deficiency can indeed give rise to Empty Heat but, in very many cases, there is just Yin deficiency without Empty Heat (see Fig. 1 and Plates 1 and 2 above).

Pathology
Dr Hong Guang Huai makes an important differentiation between Stomach-Yin and Spleen-Yin deficiency. He says that in Stomach-Yin deficiency there is a deficiency of fluids while in Spleen-Yin deficiency there is a deficiency of Ying and Blood. They are both Yin deficiency as fluids, Ying and Blood are all part of Yin.2  

Diagnosis
Dr Mao Jiong divides the clinical manifestations of Spleen-Yin deficiency into three groups and this may help the diagnostic process.  The three groups are:

- Digestive symptoms: abdominal distension, poor appetite, dry stools.
- Yin deficiency symptoms (dryness): dry mouth and throat, dry lips.
- Lack of nourishment signs: dull complexion, thin body, dry skin. 

As mentioned above, dry lips is quite a key, distinctive sign of Spleen-Yin deficiency.  Another very distinctive sign are small transversal cracks on the sides of the tongue (Plates 3-4-5). 

Plate 3. Spleen-Yin deficiency cracks

Plate 4. Spleen-Yin deficiency cracks

Plate 5. Spleen-Yin deficiency cracks


Herbal Treatment
One must nourish Yin, strengthen the Spleen, nourish Ying and “lift” fluids. Doctor Wang Guang Jun summarizes the treatment in four words: sweet, sour, moisten, lift.

By “sweet” he means using herbs (and foods) with a sweet taste and the main herbs he advocates   are Huang Jing Rhizoma Polygonati, Tai Zi Shen Radix Pseudostellariae, Shan Yao Radix Dioscoreae oppositae and Bai Bian Dou Semen Dolichoris lablab

By “sour” he means herbs (or foods) with a sour taste because the sour taste keeps fluids in and it therefore nourishes Yin. Bai Shao Radix Paeoniae alba, Wu Mei Prunus Mume, Wu Wei Zi Fructus Schisandrae chinensis, Shan Zha Fructus Crataegi

By “moisten”, he means the use of herbs that are rich in fluids such as Lian Rou (lotus fruit).  By “lifting” he means the use of herbs that lift Qi such as Ge Gen Radix Puerariae and Sheng Ma Rhizoma Cimicifugae

Bearing these four principles in mind, Dr Wang recommends the following prescription to nourish Spleen-Yin. 

Huang Jing Rhizoma Polygonati
Tai Zi Shen Radix Pseudostellariae
Shan Yao Radix Dioscoreae oppositae 
Bai Bian Dou Semen Dolichoris lablab
Bai Shao Radix Paeoniae alba
Shan Zha Fructus Crataegi
Wu Mei Prunus Mume
Ge Gen Radix Puerariae 
Lian Zi Semen Nelumbinis nuciferae 
Da Zao Fructus Jujubae
Gan Cao Radix Glycyrrhizae

Dr Hong Guang Huai also recommends nourishing Yin and strengthening the Spleen and he says that two important herbs are Ren Shen Radix Ginseng and Tian Hua Fen Radix Trichosanthis. He recommends the following herbs for Stomach-Yin and Spleen-Yin:

Stomach-Yin: Mai Men Dong Tuber Ophiopogonis, Bei Sha Shen Radix Glehniae, Yu Zhu Rhizoma Polygonati odorati, Shi Hu Herba Dendrobii.

Spleen-Yin: Ren Shen Radix Ginseng, Tian Hua Fen Radix Trichosanthis, E Jiao Colla Corii Asini, Sheng Di Huang Radix Rehmanniae.

He also recommends herbs with a sweet and bland taste for Spleen-Yin such as Shan Yao Radix Dioscoreae oppositae, Lian Rou (lotus fruit), Geng Mi (rice), Mai Ya Fructus Hordei vulgaris germinatus, Tai Zi Shen Radix Pseudostellariae, Xi Yang Shen Radix Panacis quinquefolii, Bei Sha Shen Radix Glehniae littoralis, Ge Gen Radix Puerariae, He Ye Folium Nelumbinis

He recommends the following formulae for Spleen-Yin deficiency:
- Ren Shen Gu Ben Tang Ginseng Consolidating the Root Decoction.
- Zhi Gan Cao Tang Glycyrrhiza Decoction (without Gui Zhi Ramulus Cinnamomi and with the addition of Bai Shao Radix Paeoniae alba).
- Yu Quan Wan Jade Spring Pill

Acupuncture Treatment
The acupuncture treatment of Spleen-Yin deficiency is based on the following points: Ren-12 Zhongwan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-13 Zhangmen. 

As Spleen-Yin deficiency very often occurs in conjunction with Stomach-Yin deficiency, I outline below the clinical manifestations and treatment of Stomach-Yin deficiency.

Stomach-Yin deficiency
No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon with desire to drink in small sips, slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the Right-Middle position (Plates 6-7-8-9). 
Plate 6. Stomach cracks.

Plate 7. Two patches without coating

Plate 8. Central Stomach crack

Plate 9. No coating in the centre. 


If there is Empty Heat, there will be some additional symptoms such as feeling of hunger, night-sweating, 5-palm heat, bleeding gums, feeling of heat in the evening, red tongue without coating in the centre, Floating-Empty pulse on the Right-Middle position and slightly Rapid. 

Points: Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao.

Herbal formulae (for Stomach-Yin)
Sha Shen Mai Dong Tang Glehnia-Ophiopogon Decoction.
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.
Yi Wei Tang Benefiting the Stomach Decoction.

Three Treasures for Stomach-Yin and Spleen-Yin
The Three Treasures remedies for Stomach- and Spleen-Yin deficiency are:

Central Mansion (variation of Shen Ling Bai Zhu San).
Jade Spring (variation of Sha Shen Mai Dong Tang).

Central Mansion is used for the beginning stages of Stomach- and Spleen-Yin deficiency: in such cases, the tongue will has some coating which is missing only in patches.

Jade Spring is used in full-blown Stomach- and Spleen-Yin deficiency: in such cases, the tongue has no coating at all.

Plates 10 and 11 illustrate the difference between Central Mansion and Jade Spring
Plate 10. Partially without coating. Central Mansion

Plate 11. Completely without coating. Jade Spring


END NOTES
1. The Symptoms and Treatment of Spleen-Yin deficiency by Wang Guang Jun in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 2, 1990, p. 18.

2. Concerning the Differentiation between Stomach-Yin and Spleen-Yin Deficiency by Hong Guang Gui Huai in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 7, 1990, p. 4.

3. Introduction to Research on Spleen-Yin Deficiency by Mao Jiong in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 32, no. 5, 1991, p. 50.

PRESCRIPTIONS
ZHI GAN CAO TANG
Glycyrrhiza Decoction
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 
Ren Shen Radix Ginseng 
Da Zao Fructus Jujubae 
Sheng Di Huang Radix Rehmanniae 
Mai Men Dong Radix Ophiopogonis 
E Jiao Colla Corii Asini 
Hu Ma Ren Semen Sesami indici
Sheng Jiang Rhizoma Zingiberis recens 
Gui Zhi Ramulus Cinnamomi cassiae 
Qing Jiu Rice wine 10 ml (added at the end)

REN SHEN GU BEN TANG
Ginseng Consolidating the Root Decoction 
Ren Shen Radix Ginseng
Shan Yao Radix Dioscoreae oppositae
Sheng Di Huang Radix Rehmanniae
Shu Di Huang Radix Rehmanniae preparata
Tian Men Dong Tuber Asparagis cohinchinensis
Mai Men Dong Tuber Ophiopogonis
Fu Ling Poria
Shan Zhu Yu Fructus Corni officinalis
Mu Dan Pi Cortex Moutan
Ze Xie Rhizoma Alismatis orientalis

YU QUAN TANG
Jade Spring Decoction
Huang Lian Radix Coptidis
Ge Gen Radix Puerariae
Tian Hua Fen Radix Trichosanthis
Zhi Mu Radix Anemarrhenae asphodeloidis
Mai Men Dong Tuber Ophiopogonis
Ren Shen Radix Ginseng
Wu Wei Zi Fructus Schisandrae
Sheng Di Huang Radix Rehmanniae
Lian Rou Lotus fruit
Wu Mei Prunus Mume
Dang Gui Radix Angelicae sinensis
Gan Cao Radix Glycyrrhizae uralensis
(plus human milk, cow’s milk, lotus juice, pear juice)

Sunday, May 18, 2014

ITCHING

Itching is a symptom that accompanies many diseases and patterns.  The main pathogenic factors that cause itching are:
Heat
External Wind
Wind in the skin
Dampness
Blood deficiency

For each pathogenic factor I will give the general acupuncture points for treatment.  Please note that these are only general points and other points depend on the disease and the part of the body affected. Please note that Baichongwo is an extra point located 1 cun above SP-10 Xuehai. Its name means "100 insects nest", a clear reference to its action on itching that feels as if insects were crawling under the skin. 

In the lists of points, I mention HE-7 Shenmen because, besides calming the Shen, it stops itching.

Heat
The itching caused by Heat manifests with red skin eruptions of the papular type.  It is seen in various diseases such as herpes.  In order to diagnose Heat as the cause of itching the tongue is important: it must be red with a yellow coating and possibly red points.

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

Red papules
                                                                     

Red body with red points

External Wind
External Wind may cause itching such as itchy throat or itchy nose. 

Acupuncture: BL-12 Fengmen, TB-5 Waiguan, LU-7 Lieque, LI-4 Hegu. 

Wind the skin
By “Wind in the skin” I refer to a type of Wind that is neither internal nor external, but closer to the latter. Wind is a major pathogenic factor in skin diseases and it escapes a classification into internal or external.  

Wind in the skin is a major cause of itching in skin diseases.  It is characterized by being all over the body or moving from place to place. For example, in urticaria, the intense itching is caused by Wind in the skin.  Wind in the skin is also the cause of itching is certain types of eczema. We can diagnose Wind in the skin only when the itching involves the whole body or when it moves from place to place: if the itching is confined to one specific area, it is not Wind. 

Another characteristic of itching from Wind is that often there is nothing to be seen on the skin (although of course in urticaria there are bullae and in eczema papules).  Wind in the skin is the cause of itching in herpes zoster (but remember that this is also caused by Dampness).

Acupuncture: GB-31 Fengshi, TB-6 Zhigou, Baichongwo extra point, LIV-3 Taichong, HE-7 Shenmen.

Urticaria

Dampness
Dampness is a frequent cause of itching. Its main characteristic is that the itching is usually confined to one place.  For example, the itching from vaginitis or herpes is confined to the genitals.  The itching from Dampness manifests with vesicles or papules.  

When Dampness is combined with Heat, the itching is more intense as it is caused by the combined effect of both Dampness and Heat.  Damp-Heat is a major pathogenic factor in eczema: it is very important to treat the itching in eczema because scratching aggravates this disease significantly.  Indeed some of the pathology of eczema is caused by the scratching rather than the disease itself. Scratching causes skin erosion and it may facilitate the entry of bacteria that cause skin infections. 

Acupuncture: Ren-9 Shuifen, Ren-5 Shimen, BL-22 Sanjiaoshu, SP-9 Yinlingquan, Baichongwo, HE-7 Shenmen.

Herpes Zoster  (Damp-Heat)

Herpes simplex (Damp-Heat)
Genital herpes (Damp-Heat)

Blood deficiency
In Blood deficiency the itching is generalized, i.e not confined to a specific area. An important characteristic of itching from Blood deficiency is that is may occur without any skin lesions.  Itching from Blood deficiency is seen in chronic eczema (in which case of course there are skin lesions) and in psoriasis. 

The itching from Blood deficiency may also be accompanied by other changes in the skin such as dryness and desquamation: this is seen a lot in psoriasis. 

Acupuncture: LIV-8 Ququan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, HE-7 Shenmen.

Desquamation
Erosion

Itching may also be classified according to Chinese categories of pathogenic factors as follows:
Du (Toxin)
Feng (Wind)
Jiu (Alcohol)
Re (Heat)

Du (Toxin)
The itching from Toxin manifests with erosion, papules or bullae and it appears suddenly.  Contact dermatitis is a good example of it.   

Acupuncture: BL-40 Weizhong, SP-10 Xuehai.

Bullae


Feng (Wind)
The itching from Wind is generalized.  It may be from external Wind or Wind in the skin as defined above.  It may also be from Internal Wind in which case it would manifest with desquamation. 

Acupuncture: GB-31 Fengshi, BL-12 Fengmen, GB-20 Fengchi, Du-16 Fengfu, TB-17 Yifeng.

Jiu (Alcohol)
This is the itching that affects people after drinking alcohol. This occurs in people who are not usual drinkers.  

Acupuncture: LIV-3 Taichong, SP-10 Xuehai, HE-7 Shenmen. 

Re (Heat)
As we have sen above, Heat is a common cause of itching and it may manifest with red bullae or papules. 

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

THE PO AND ITCHING
The Po is the physical soul that resides in the Lungs. It is always contrasted with the Hun that resides in the Liver.  The Hun is Yang and survives after death; the Po is Yin and dies with the body.  

Zhang Jie Bin says: “The Po can move and do things and [when it is active] pain and itching can be felt”.  The Po is responsible for sensations and itching and is therefore closely related to the skin through which such sensations are experienced. For this reason, in itching, I also treat the Lungs with LU-7 Lieque. 

HERBS THAT EXPEL WIND IN SKIN DISEASES
Fang Feng Radix Saposhnikoviae
Jing Jie Herba Schizonepetae
Chan Tui Periostracum Cicadae
Cang Er Zi Fructus Xanthii
Bo He Herba Menthae haplocalycis
Niu Bang Zi Fructus Arctii

HERBS THAT RELIEVE ITCHING
Chan Tui Periostracum Cicadae
Ku Shen Radix Sophorae flavescentis
She Chuang Zi Fructus Cnidii
Xu Chang Qing Radix Cynanchi paniculati